Pain Neuroscience “Communication” vs. Pain Neuroscience Education

Align 2019 in Denver was another great experience with almost 400 health care providers networking and learning more about pain. The presentations had nugget after nugget of great information to advance our care for those with pain. If you did not make it, check out #align2019 for a recap of some of the great tweets. Also consider coming next year so you do not have to read the cliff notes version, but instead experience it live.

One of the biggest take homes for me was when Jo Nijs talked about the idea of pain neuroscience education as pain neuroscience “communication”. Ideally, this is what pain neuroscience education (PNE) always has been – a conversation with our patient. However, I liked the idea of emphasizing this point by labeling more of what it is “communication” over “education”.

Education often brings to mind the idea of the instructor standing in front of a person or classroom in a one-way fashion delivering information. Whereas, communication is more about a two-way conversation between two individuals coming to a shared understanding.

A more patient centered approach, which is what PNE has always been about, is centered on the idea of shared decision-making. This shared decision-making requires a back and forth of information from the patient and therapist to help guide the patient-therapist team on different treatment options. PNE is providing the patient with current pain neuroscience to help them understand more clearly, why they hurt and reducing threat. While we are educating them more about pain, it does not necessarily mean the patient has to become smarter from a testing perspective about how pain works.

Our research team along with other researchers have done multiple studies showing patients, health care providers, and middle school kids usually do generally increase their knowledge on pain when they have received PNE. Interesting though is looking at some of the data on a case-by-case basis. In one of our studies, there was an individual that rated receiving PNE was very helpful in their recovery over the one-year that their outcomes were measured. Their improvement in pain and function confirmed that with full return to function and no pain. Interestingly, their pain knowledge actually got worse when measured through the pain neurophysiology pain questionnaire (NPQ). This was not just a little difference, they originally got 15 out of the original 19 questions correct on the NPQ and at one year scored only 8 correct of the 19 questions.

Which begs the question, how much smarter about pain does your patient need to get to have a successful outcome?

This highlights the idea that PNE is in many ways less about just basic neuroscience education and making someone smarter about pain, but a conversation through a patient-centered approach to explore where a patient may need some information to help them make sense of why they hurt and the treatment options that may be helpful.